Aseptic Technique and Equipment Practice Questions

74 multiple-choice questions on Aseptic technique and equipment for paramedic and EMT students, from Chapter 14 (Medication Administration). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

74 practice questions

1. Medical asepsis refers to:

   1. A. Wearing sterile gloves for all procedures
   2. B. Complete elimination of all microorganisms
   3. C. Sterilizing the skin before every injection
   4. D. Reducing pathogens and preventing spread
   Show answer

   Answer: D. Reducing pathogens and preventing spread

   Surgical asepsis aims for complete absence of organisms.

2. Before drawing up a medication from a vial, the paramedic should:

   1. A. Warm the vial in your hands first
   2. B. Swab the stopper with alcohol, let it dry
   3. C. Shake the vial vigorously to mix it
   4. D. Remove the rubber stopper to draw it up easily
   Show answer

   Answer: B. Swab the stopper with alcohol, let it dry

   The stopper is not sterile, even on a new vial.

3. A glass ampule should be opened by:

   1. A. Snapping the top toward you, using gauze
   2. B. Tapping the base, then pulling the top straight up
   3. C. Twisting the top off with bare fingers
   4. D. Snapping the top away from you, using gauze
   Show answer

   Answer: D. Snapping the top away from you, using gauze

   Tap the medication out of the neck, wrap the neck in gauze, and snap the top away from you at the scored neck; then draw up with a filter needle to catch glass fragments. Snapping toward yourself aims glass at your face and hands, twisting with bare fingers risks cuts, and an ampule is opened by snapping at the scored neck rather than by pulling the top straight up.

4. Needle gauge numbers work such that:

   1. A. A higher number means a smaller diameter
   2. B. The number indicates the volume it holds
   3. C. The number indicates the needle length
   4. D. A higher number means a larger diameter
   Show answer

   Answer: A. A higher number means a smaller diameter

   An 18-gauge needle is larger than a 25-gauge.

5. For intramuscular injection in an average adult, a typical needle is:

   1. A. 16 to 18 gauge, 2 to 3 inches
   2. B. 25 to 27 gauge, 3/8 to 5/8 inch
   3. C. 21 to 23 gauge, 1 to 1.5 inches
   4. D. 27 to 30 gauge, 1/4 to 1/2 inch
   Show answer

   Answer: C. 21 to 23 gauge, 1 to 1.5 inches

   The needle must reach muscle, not stop in fat.

6. For subcutaneous injection, a typical needle is:

   1. A. 14 to 16 gauge, 2 inches
   2. B. 24 to 26 gauge, 3/8 to 5/8 inch
   3. C. 20 to 22 gauge, 1 to 1.5 inches
   4. D. 18 to 20 gauge, 1 to 1.5 inches
   Show answer

   Answer: B. 24 to 26 gauge, 3/8 to 5/8 inch

   Injection is at a 45-degree angle in most patients.

7. Once a needle touches a nonsterile surface, it should be:

   1. A. Discarded and replaced
   2. B. Used if not visibly contaminated
   3. C. Wiped with an alcohol prep pad
   4. D. Briefly flamed with a lighter
   Show answer

   Answer: A. Discarded and replaced

   Contamination cannot be reversed.

8. When assembling a prefilled cartridge syringe (such as a Luer-Jet), you should:

   1. A. Shake the vial hard before removing the caps
   2. B. Remove both caps, then screw the vial in
   3. C. Push the vial in with the caps left on
   4. D. Draw the drug out with a separate needle
   Show answer

   Answer: B. Remove both caps, then screw the vial in

   Prefilled cartridge systems (used for epinephrine 0.1 mg/mL, dextrose, and bicarbonate) are assembled by removing the protective caps from the vial and the injector, threading them together, and expelling air. Shaking is unnecessary, caps left on prevent assembly, and drawing the drug out with a needle defeats the closed system.

9. A prefilled syringe such as those used in cardiac arrest:

   1. A. Needs no label check because it is standard
   2. B. Must always be diluted before use
   3. C. Has a set dose that still must be verified
   4. D. May be used past its expiration date
   Show answer

   Answer: C. Has a set dose that still must be verified

   Verify the concentration; look-alike packaging causes errors.

10. A multidose vial:

    1. A. Remains sterile indefinitely after opening
    2. B. Needs no cleaning once the cap is removed
    3. C. Needs its stopper cleaned before each entry
    4. D. Must be discarded after one use in all cases
    Show answer

    Answer: C. Needs its stopper cleaned before each entry

    It must also be labeled and dated per policy. Single-patient use is safest.

11. A methylprednisolone two-chamber vial (Act-O-Vial) is prepared by:

    1. A. Adding 10 mL of saline from your own syringe
    2. B. Drawing the powder up dry, then diluting
    3. C. Pressing the cap to release the diluent
    4. D. Removing the cap and pouring in water
    Show answer

    Answer: C. Pressing the cap to release the diluent

    A two-chamber vial holds powder and diluent separated by a stopper; pressing the plastic activator forces the diluent into the powder, then you swirl gently until dissolved. Adding your own saline or pouring in water changes the concentration and breaks sterility, and dry powder cannot be drawn into a syringe.

12. Medication that has been reconstituted should be:

    1. A. Used at any time during the remaining shift
    2. B. Labeled with the drug name alone
    3. C. Labeled with concentration and time prepared
    4. D. Kept until the original vial's printed expiry date
    Show answer

    Answer: C. Labeled with concentration and time prepared

    Use it within the recommended period. Reconstitution errors change the concentration significantly. A name alone omits the concentration and time, and the vial's printed expiry no longer applies once it is mixed; the stability window after reconstitution is much shorter.

13. Proper glove use during medication administration:

    1. A. Is unnecessary for routine injections
    2. B. Applies only when starting IV lines
    3. C. Replaces the need for hand hygiene
    4. D. Is part of standard precautions
    Show answer

    Answer: D. Is part of standard precautions

    Gloves apply to any procedure involving needles or body fluids. Wash or sanitize hands before and after.

14. Overnight an ambulance heater fails and the drug box freezes. What is the correct response?

    1. A. Use them, since cold preserves drugs
    2. B. Thaw them quickly on the dashboard heater
    3. C. Quarantine them; follow pharmacy policy
    4. D. Shake each vial well, then use it
    Show answer

    Answer: C. Quarantine them; follow pharmacy policy

    Freezing can crack vials, separate emulsions and suspensions, and damage protein drugs such as glucagon, so remove the affected stock from service and follow pharmacy or medical director guidance on replacement. Cold below the labeled range does not preserve drugs, rapid heating causes further damage, and shaking cannot reverse freeze damage.

15. Aseptic technique means:

    1. A. Preventing pathogen entry during procedures
    2. B. Sterilizing the patient's skin completely
    3. C. Disinfecting the ambulance after each call
    4. D. Giving antibiotics before invasive procedures
    Show answer

    Answer: A. Preventing pathogen entry during procedures

    Asepsis minimizes contamination of equipment and injection sites.

16. Which field procedure calls for sterile (surgical) technique rather than clean technique?

    1. A. Giving an IM injection in the thigh
    2. B. Accessing an implanted central port
    3. C. Placing a peripheral IV in the forearm
    4. D. Giving a nebulized bronchodilator
    Show answer

    Answer: B. Accessing an implanted central port

    Accessing an implanted port enters a central vein through a device that can stay in for years, so it needs sterile gloves, mask, sterile field, and a noncoring (Huber) needle per protocol. IM injections, peripheral IVs, and nebulizers use clean (medical aseptic) technique with skin antisepsis and a no-touch approach.

17. When using alcohol-based hand rub, you should keep rubbing until:

    1. A. Ten seconds pass, then wipe on a towel
    2. B. The product foams, then rinse with water
    3. C. Your hands are dry, about 20 seconds
    4. D. You feel the gel start to sting
    Show answer

    Answer: C. Your hands are dry, about 20 seconds

    Cover all surfaces of the hands and rub until they are dry, which takes about 20 seconds with an adequate amount of product. Wiping off after 10 seconds removes the alcohol before it works, rinsing is not part of alcohol rub, and stinging is not an endpoint.

18. To avoid 'coring' a rubber stopper when entering a vial, you should insert the needle:

    1. A. Bevel up at an angle, then upright
    2. B. Bevel down, straight in, with force
    3. C. Repeatedly through one puncture site
    4. D. Sideways through the stopper's edge
    Show answer

    Answer: A. Bevel up at an angle, then upright

    Entering bevel up at an angle and then bringing the needle upright lets the bevel slice rather than punch a plug of rubber (a 'core') that could be drawn into the syringe. Forcing the needle straight in bevel down, reusing one puncture repeatedly, and entering at the stopper's edge all raise the risk of coring or leaks.

19. An ampule is:

    1. A. A sealed glass container broken to open
    2. B. A prefilled single-dose syringe
    3. C. A plastic bag of premixed drug
    4. D. A multidose vial with a rubber stopper
    Show answer

    Answer: A. A sealed glass container broken to open

    Ampules contain a single dose of liquid medication.

20. Unlike a vial, an opened ampule does not need air injected before withdrawing the drug because:

    1. A. Air would shatter the glass ampule
    2. B. The drug in it is under high pressure
    3. C. Ampules hold powder, not liquid
    4. D. It is open, so no vacuum forms
    Show answer

    Answer: D. It is open, so no vacuum forms

    A vial is sealed, so withdrawing fluid creates a vacuum unless air is added; an opened ampule is open to the room, so no vacuum forms. Air does not shatter the ampule, its contents are not under pressure, and ampules contain liquid, not powder.

21. While withdrawing from an inverted vial, air keeps entering the syringe. The fix is to:

    1. A. Pull the plunger back faster and much harder
    2. B. Turn the vial upright while drawing
    3. C. Keep the needle tip below the fluid line
    4. D. Inject more air after each 0.1 mL drawn
    Show answer

    Answer: C. Keep the needle tip below the fluid line

    Air enters when the needle tip rises above the fluid into the air space, so keep the tip below the fluid line as the level drops. Pulling harder draws in more air and foam, turning the vial upright puts the tip in the air space, and repeated air injections build pressure without fixing the tip position.

22. A multiple-dose vial of lidocaine was used at the bedside next to a patient on the stretcher. Per CDC guidance, that vial should now be:

    1. A. Returned to stock for the next patient
    2. B. Wiped with alcohol and shared freely
    3. C. Refrigerated and used within 28 days
    4. D. Kept for that patient, then discarded
    Show answer

    Answer: D. Kept for that patient, then discarded

    CDC guidance: a multiple-dose vial taken into the immediate patient-care area should be dedicated to that one patient and then discarded, because it may have been contaminated. Returning it to stock or sharing it risks transmitting infection, wiping the stopper does not make shared use safe, and the 28-day rule applies to vials kept in a clean medication area.

23. Some clinicians draw a thick medication with an 18-gauge needle and then switch to a 23- to 25-gauge needle to inject because:

    1. A. An 18-gauge needle cannot pierce a stopper
    2. B. Large bore draws fast; fine bore hurts less
    3. C. A fine needle filters out stopper particles
    4. D. A large bore deposits the drug too deep
    Show answer

    Answer: B. Large bore draws fast; fine bore hurts less

    A large-bore needle draws viscous fluid quickly, and a fresh, finer needle is sharper and less painful for the injection. An 18-gauge needle pierces stoppers easily, a standard fine needle is not a filter (filter needles are a separate device), and injection depth depends on needle length, not bore.

24. On standard peripheral IV catheters, a green hub indicates which gauge?

    1. A. 22 gauge
    2. B. 14 gauge
    3. C. 18 gauge
    4. D. 24 gauge
    Show answer

    Answer: C. 18 gauge

    Under the international color code, 14-gauge is orange, 16 gray, 18 green, 20 pink, 22 blue, and 24 yellow. Always confirm the printed gauge, since color is a cue, not a substitute for reading the label.

25. For an IM deltoid injection in a 120-kg man, CDC guidance suggests a needle length of:

    1. A. 0.5 inch
    2. B. 0.75 inch
    3. C. 3.5 inches
    4. D. 1.5 inches
    Show answer

    Answer: D. 1.5 inches

    Thicker subcutaneous tissue requires a longer needle to reach muscle; CDC recommends a 1.5-inch needle for the deltoid in men over 118 kg (260 lb) and women over 90 kg (200 lb). A 0.5- or 0.75-inch needle would likely leave the drug in fat, and 3.5 inches is a spinal-needle length.

26. After giving subcutaneous heparin or enoxaparin, you should not rub the site because rubbing:

    1. A. Inactivates the anticoagulant
    2. B. Increases bruising at the site
    3. C. Pushes the drug into a nearby vein
    4. D. Breaks off the needle tip
    Show answer

    Answer: B. Increases bruising at the site

    Rubbing an anticoagulant injection site increases bruising and hematoma, so labeling advises against it. Rubbing does not inactivate the drug, push it into a vein, or break a needle that has already been withdrawn.

27. Syringe sizes for most EMS medication administration are:

    1. A. 50–60 mL for most doses
    2. B. 1–10 mL depending on the volume
    3. C. 20–60 mL regardless of the volume
    4. D. 100 mL piggyback syringes
    Show answer

    Answer: B. 1–10 mL depending on the volume

    Choose a syringe close to the volume to be given for accuracy.

28. A tuberculin syringe holds:

    1. A. 3 mL with 0.1-mL markings
    2. B. 5 mL with 0.2-mL markings
    3. C. 1 mL with 0.01-mL markings
    4. D. 10 mL with 0.5-mL markings
    Show answer

    Answer: C. 1 mL with 0.01-mL markings

    Used for small, precise volumes like pediatric or SC doses.

29. The parts of a syringe that must remain sterile are:

    1. A. The barrel markings and plunger end
    2. B. The outer barrel and the finger flange
    3. C. The flange and the plunger thumb rest
    4. D. Plunger shaft, tip, and inner barrel
    Show answer

    Answer: D. Plunger shaft, tip, and inner barrel

    Touching the plunger shaft contaminates what enters the barrel.

30. When drawing up medication, injecting air into the vial first:

    1. A. Equalizes pressure for easier withdrawal
    2. B. Is dangerous and may shatter the vial
    3. C. Dilutes the drug to a lower strength
    4. D. Is unnecessary for single-dose vials
    Show answer

    Answer: A. Equalizes pressure for easier withdrawal

    Air equal to the volume to be withdrawn is injected into the vial.

31. According to CDC, fingerstick lancet devices used for glucose checks should be:

    1. A. Cleaned with alcohol between patients
    2. B. Shared if the lancet tip is changed
    3. C. Single-patient use, auto-disabling
    4. D. Reused for the same shift's patients
    Show answer

    Answer: C. Single-patient use, auto-disabling

    CDC: fingerstick devices must never be shared; use single-use, auto-disabling lancets, and clean and disinfect the glucose meter between patients. Outbreaks of hepatitis B have followed shared lancet holders even when the tip was changed or the device was wiped with alcohol.

32. Why must an ambulance sharps container be mounted and kept upright?

    1. A. A loose or tipped box can spill sharps
    2. B. Upright boxes hold more sharps when full
    3. C. It lets the box be reopened to check it
    4. D. A mounted box need not be closed when full
    Show answer

    Answer: A. A loose or tipped box can spill sharps

    OSHA requires sharps containers to be kept upright, closable, and puncture-resistant; in a moving vehicle a loose or tipped box can spill used needles. Upright mounting prevents spills rather than adding capacity, sharps containers are not reopened, and they are closed and replaced at the fill line.

33. The snapped-off top of a glass ampule should be discarded in:

    1. A. A red biohazard bag
    2. B. The sharps container
    3. C. The regular trash
    4. D. The drug box for return
    Show answer

    Answer: B. The sharps container

    Broken ampule glass can cut through bags and gloves, so it goes into a puncture-resistant sharps container. A red bag and the regular trash can be pierced and injure handlers, and the drug box is not a disposal site.

34. Where should medications be drawn up in the ambulance?

    1. A. On the stretcher next to the patient
    2. B. On the bench seat beside the airway kit
    3. C. On a clean, dedicated work surface
    4. D. On the drug box lid wherever it sits
    Show answer

    Answer: C. On a clean, dedicated work surface

    CDC safe-injection practice: prepare medications in a clean area away from blood, body fluids, and used equipment. The stretcher, the bench seat, and a drug box lid set down wherever it lands are shared surfaces that pick up blood and body fluids, so none is a clean, dedicated area.

35. Medication vials should be inspected for:

    1. A. Expiration date, clarity, and seal
    2. B. Manufacturer name and lot number only
    3. C. Label color and cap color only
    4. D. Fill volume and vial weight only
    Show answer

    Answer: A. Expiration date, clarity, and seal

    Also check for particulates and discoloration. Any abnormality means the drug should not be used.

36. A reconstituted drug (e.g., glucagon) requires:

    1. A. Diluting the powder with D5W first
    2. B. Adding diluent to powder and mixing
    3. C. Shaking the mixed vial until it foams
    4. D. No mixing before administration
    Show answer

    Answer: B. Adding diluent to powder and mixing

    Reconstitution follows the manufacturer's instructions. Glucagon is mixed with the diluent supplied in the kit, not D5W, and it is swirled gently until clear because hard shaking can damage the drug; a powder cannot be given unmixed.

37. IV fluid bags should be checked for:

    1. A. Only the volume printed on the label
    2. B. Volume and expiration date alone
    3. C. Lot number and bag weight
    4. D. Expiration, clarity, leaks, and type
    Show answer

    Answer: D. Expiration, clarity, leaks, and type

    Cloudy or leaking fluid is discarded. Volume and expiration alone miss cloudiness, leaks, and the wrong fluid type, and the lot number and bag weight do not show whether the fluid is safe to infuse.

38. When giving a nebulized treatment to a patient with suspected tuberculosis or another airborne infection, crew PPE should include:

    1. A. Gloves alone, since nebs are low risk
    2. B. A fit-tested N95 plus eye protection
    3. C. A surgical mask on the patient instead
    4. D. No PPE if the windows are open
    Show answer

    Answer: B. A fit-tested N95 plus eye protection

    Nebulization can aerosolize respiratory secretions, so for a suspected airborne infection the crew wears a fit-tested N95 (or higher) respirator with eye protection, plus gloves, and maximizes ventilation. Gloves alone do not protect the airway, a surgical mask cannot be worn by a patient receiving a nebulizer, and open windows do not replace a respirator.

39. Color-coded syringe labels for drug classes are meant to:

    1. A. Replace the need to read the drug name
    2. B. Show the drug's expiration date
    3. C. Show which drugs are controlled
    4. D. Support, not replace, reading the name
    Show answer

    Answer: D. Support, not replace, reading the name

    Class color coding (for example, red for neuromuscular blockers) is a backup cue; the drug name and concentration on the label must still be read every time. Color does not replace reading the label, and it does not show the expiration date or controlled status.

40. A prefilled 10-mL saline flush syringe is opened and half of it used. The remaining saline should be:

    1. A. Discarded after use on this patient
    2. B. Saved for flushing the next patient's IV
    3. C. Used to dilute other drugs later
    4. D. Returned to its sealed package
    Show answer

    Answer: A. Discarded after use on this patient

    Prefilled flush syringes are single-use, single-patient products; discard the remainder after use on this patient. Saving it for another patient, using it later as a diluent, or repackaging it all risk contamination and cross-infection.

41. The Luer-Lok connection:

    1. A. Is obsolete and no longer used in EMS
    2. B. Is a friction slip-fit connection
    3. C. Is used only for IV fluid bags
    4. D. Threads securely onto the syringe
    Show answer

    Answer: D. Threads securely onto the syringe

    Luer-Lok reduces accidental disconnection under pressure.

42. Glass ampule shards in the medication can cause:

    1. A. No harm as long as the drug is given IM
    2. B. Tissue injury or embolism if injected
    3. C. Loss of the drug's potency
    4. D. Nothing; they dissolve in the drug
    Show answer

    Answer: B. Tissue injury or embolism if injected

    Glass particles can injure tissue at an IM site as well as embolize when given IV; they do not change potency and do not dissolve. Hence the filter needle.

43. When unsure whether a vial has been contaminated, the paramedic should:

    1. A. Use it if the seal looks intact
    2. B. Discard it and use a new one
    3. C. Wipe it with alcohol and use it
    4. D. Use it only for IV doses
    Show answer

    Answer: B. Discard it and use a new one

    When in doubt, throw it out.

44. Some drugs, such as epinephrine, must stay in their cartons until use because they:

    1. A. Are Schedule II controlled substances
    2. B. React with the plastic drug box
    3. C. Lose potency in humid air
    4. D. Degrade when exposed to light
    Show answer

    Answer: D. Degrade when exposed to light

    Light-sensitive drugs such as epinephrine break down with light exposure, so labeling directs storage in the carton or an amber container. Epinephrine is not a controlled substance, and it is light, not the plastic box or the humidity around a sealed vial, that the carton guards against.

45. You need a second dose from the same single-patient vial after giving the first. You should enter the vial with:

    1. A. The same syringe with a fresh needle
    2. B. The same needle and syringe
    3. C. A new sterile needle and syringe
    4. D. The used syringe, wiped clean
    Show answer

    Answer: C. A new sterile needle and syringe

    CDC: never enter a vial with a used syringe or needle, even for the same patient, because a used syringe can carry blood back into the vial. Changing only the needle, reusing both, or wiping the syringe tip does not remove that contamination.

46. You inject 5 mL of air into a vial before drawing up 1 mL. The likely problem is:

    1. A. The drug is diluted by the added air
    2. B. The vial will form a strong vacuum
    3. C. High pressure may spray the drug out
    4. D. The air sterilizes the drug in the vial
    Show answer

    Answer: C. High pressure may spray the drug out

    Air should roughly match the volume withdrawn; a large excess pressurizes the vial so the drug can spray out or push the plunger back. Air does not dilute the drug, excess air creates pressure rather than a vacuum, and air does not sterilize anything.

47. You draw up a medication and see a large air bubble in the syringe. The correct action is to:

    1. A. Inject it, since air in a syringe is harmless
    2. B. Draw more medication in to dilute the bubble
    3. C. Hold it needle-up, tap, and expel the air
    4. D. Point the needle down and push the plunger in
    Show answer

    Answer: C. Hold it needle-up, tap, and expel the air

    Tapping moves bubbles to the hub so they can be expelled, ensuring accurate volume.

48. After drawing medication from a glass ampule, the filter needle should be:

    1. A. Left on the syringe for the injection
    2. B. Kept on to filter an IM dose
    3. C. Swapped for a standard needle
    4. D. Reused for the next ampule
    Show answer

    Answer: C. Swapped for a standard needle

    Filter needles trap glass particles; injecting through them would push the particles into the patient. Replace it with a standard needle before injecting the patient.

49. For IO infusion analgesia, the lidocaine used should be:

    1. A. Lidocaine with epinephrine
    2. B. Viscous oral lidocaine solution
    3. C. Lidocaine 4% topical jelly
    4. D. Preservative-free 2% lidocaine
    Show answer

    Answer: D. Preservative-free 2% lidocaine

    IO analgesia uses preservative-free 2% (cardiac) lidocaine, which is safe to enter the circulation. Lidocaine with epinephrine causes vasoconstriction and is not for IO infusion, and viscous oral solution and topical jelly are not injectable.

50. On an over-the-needle IV catheter, blood in the flashback chamber means:

    1. A. The catheter is fully in the vein
    2. B. The vein has been punctured through
    3. C. The needle tip has entered a vein
    4. D. The tourniquet can now be removed
    Show answer

    Answer: C. The needle tip has entered a vein

    Flashback shows that the needle tip is in the vein; the catheter tip sits slightly behind it, so advance a few millimeters more before threading the catheter. It does not mean the catheter is fully in the vein, it is not a sign of through-and-through puncture, and the tourniquet stays on until the catheter is placed.

51. When reading the volume in a syringe, measure at:

    1. A. The bottom ring of the plunger seal
    2. B. The top ring of the plunger seal
    3. C. The tip of the plunger's cone
    4. D. The end of the thumb press
    Show answer

    Answer: B. The top ring of the plunger seal

    Read the volume at the leading (top) ring of the rubber plunger seal, the edge closest to the needle. The bottom ring, the cone tip, and the thumb press all give a reading that is off by part of a milliliter.

52. Which part of the needle may be touched safely during preparation?

    1. A. The bevel of the needle
    2. B. The hub where it joins the syringe tip
    3. C. The shaft of the needle
    4. D. The outside of the needle cap
    Show answer

    Answer: D. The outside of the needle cap

    The needle shaft, bevel, and hub interior must remain sterile; the outer cap is not sterile-critical.

53. Before drawing two drugs into one syringe for a single injection, you must confirm:

    1. A. That both vials come from one maker
    2. B. That both drugs are in the same class
    3. C. That the total volume is under 0.5 mL
    4. D. That the two drugs are compatible
    Show answer

    Answer: D. That the two drugs are compatible

    Some drugs precipitate or inactivate each other when mixed, so check a compatibility reference or protocol before combining them. The manufacturer, the drug class, and a small total volume say nothing about whether two drugs precipitate or inactivate each other.

54. A drug labeled as an injectable suspension looks cloudy. You should:

    1. A. Discard it because cloudy means spoiled
    2. B. Filter it through a filter needle first
    3. C. Give it IV after shaking it hard
    4. D. Check the label; suspensions are cloudy
    Show answer

    Answer: D. Check the label; suspensions are cloudy

    Suspensions are cloudy by design, so check the label; mix gently as directed and give only by the labeled route. A solution that should be clear but is cloudy is discarded, but a suspension is not spoiled. A filter needle would remove the drug particles, and IV injection of a suspension can cause embolism.

55. Alcohol prep pads should be allowed to dry before skin puncture because:

    1. A. Wet alcohol causes the needle to slip off
    2. B. Drying completes the antiseptic effect
    3. C. Drying makes the vein much easier to see
    4. D. Wet alcohol neutralizes most medications
    Show answer

    Answer: B. Drying completes the antiseptic effect

    Alcohol's antimicrobial effect is greatest as it dries, and wet alcohol stings.

56. Chlorhexidine skin prep is applied using:

    1. A. A 30-second scrub, then a saline rinse
    2. B. A back-and-forth scrub for 30 s, then air-dry
    3. C. Circles from the outside in for 10 seconds
    4. D. A quick dab, then blot dry with sterile gauze
    Show answer

    Answer: B. A back-and-forth scrub for 30 s, then air-dry

    Manufacturer guidance for chlorhexidine uses friction scrubbing and full drying to be effective.

57. A safety needle's protective sheath should be activated:

    1. A. After it is laid on the stretcher
    2. B. After the needle is wiped with alcohol
    3. C. Only if the patient has a known infection
    4. D. Right after withdrawal, one-handed
    Show answer

    Answer: D. Right after withdrawal, one-handed

    Immediate one-handed activation prevents needlestick injuries. Activate it immediately after withdrawal, with one hand, before setting the needle down.

58. If a needle must be recapped, the safest technique is:

    1. A. Pressing the cap down with your fingertips
    2. B. Asking a partner to hold the cap
    3. C. Holding the cap in your other hand
    4. D. The one-handed scoop technique
    Show answer

    Answer: D. The one-handed scoop technique

    The scoop technique keeps the other hand away from the needle tip.

59. A sharps container should be located:

    1. A. In a cabinet across the patient compartment
    2. B. Near the rear doors for easy disposal
    3. C. Under the bench seat, out of the way
    4. D. Within arm's reach at the point of use
    Show answer

    Answer: D. Within arm's reach at the point of use

    Immediate disposal at the point of use prevents carrying exposed sharps. A box across the compartment, by the doors, or under the bench forces you to carry or set down an exposed sharp before disposal.

60. A needleless system connects the syringe to an IV port by:

    1. A. A large-bore needle through the port
    2. B. A Luer connection with no needle
    3. C. A filter needle piercing the IV bag
    4. D. Removing the port cap to pour the drug
    Show answer

    Answer: B. A Luer connection with no needle

    Needleless ports and Luer connectors eliminate needles from IV medication delivery. No needle penetrates the port.

61. Before injecting into an IV port, the port should be:

    1. A. Scrubbed with alcohol, then dried
    2. B. Flushed with medication to clean it
    3. C. Left untouched to avoid contamination
    4. D. Wiped clean with a gloved fingertip
    Show answer

    Answer: A. Scrubbed with alcohol, then dried

    'Scrub the hub' reduces bacterial entry through injection ports.

62. A glass ampule's neck is wrapped in gauze when snapped mainly to:

    1. A. Protect your fingers from broken glass
    2. B. Filter glass shards out of the drug
    3. C. Keep the drug warm and sterile
    4. D. Keep the drug from freezing in transit
    Show answer

    Answer: A. Protect your fingers from broken glass

    Gauze or an ampule breaker protects the provider; a filter needle addresses glass particles.

63. Drug from an ampule may sit in the top portion before opening. The paramedic should:

    1. A. Shake the ampule hard, upside down
    2. B. Warm the ampule in the hands first
    3. C. Tap the top to move fluid down
    4. D. Snap it and draw from the top first
    Show answer

    Answer: C. Tap the top to move fluid down

    Tapping moves medication out of the stem so none is lost when it is snapped. Tap or flick the top so fluid moves into the bottom.

64. A medication requires reconstitution. After adding diluent, the vial should be:

    1. A. Shaken hard until it foams
    2. B. Refrigerated before drawing it up
    3. C. Warmed in hot water to dissolve
    4. D. Gently swirled until dissolved
    Show answer

    Answer: D. Gently swirled until dissolved

    Gentle mixing avoids foaming and protein damage; follow manufacturer instructions. Swirl or roll gently per the package insert.

65. The vial of a drug is stored at room temperature in an ambulance that reaches 120°F in summer. The concern is:

    1. A. Heat sterilizes and preserves the drug
    2. B. Heat affects only drugs in glass vials
    3. C. Heat raises potency, causing overdoses
    4. D. Heat can reduce the drug's potency
    Show answer

    Answer: D. Heat can reduce the drug's potency

    Temperature extremes degrade many drugs; storage should follow labeled ranges. Heat can degrade the drug.

66. When flushing a central venous catheter such as a PICC, why is a 10-mL-diameter syringe used?

    1. A. It flushes the line faster than a small one
    2. B. It has enough force to clear a clotted line
    3. C. Lower pressure that protects the line
    4. D. It measures the flush volume more precisely
    Show answer

    Answer: C. Lower pressure that protects the line

    Small-diameter syringes generate high pressure that can rupture a central catheter, so infusion standards call for 10-mL-diameter syringes for flushing. Speed is not the goal, a clot is not forced through a central line, and a 10-mL barrel measures small volumes less precisely, not more.

67. A needle's bevel is the:

    1. A. Gauge number printed on the hub
    2. B. Slanted opening at the needle tip
    3. C. Protective cap covering the shaft
    4. D. Plastic hub that fits onto the syringe
    Show answer

    Answer: B. Slanted opening at the needle tip

    The bevel is the angled tip that pierces tissue; bevel-up is used for most injections and cannulation.

68. For most injections and IV insertion, the needle bevel should face:

    1. A. Down
    2. B. Toward the patient's head
    3. C. Toward the patient's feet
    4. D. Up
    Show answer

    Answer: D. Up

    Bevel-up insertion allows a smoother, less painful entry.

69. Under USP rules, a dose prepared outside the pharmacy for immediate use should begin administration within:

    1. A. 4 hours
    2. B. 15 minutes
    3. C. 24 hours
    4. D. 7 days
    Show answer

    Answer: A. 4 hours

    USP <797> (2023) lets clinicians prepare immediate-use doses outside a cleanroom if administration begins within 4 hours of preparation; otherwise the dose is discarded. 15 minutes is stricter than the rule, and 24 hours or 7 days far exceed it.

70. When opening a sterile package, the first flap is opened:

    1. A. Toward you
    2. B. Toward the patient's face
    3. C. Over the sterile field
    4. D. Away from you
    Show answer

    Answer: D. Away from you

    Open the first flap away from you so you never reach across the sterile interior; then open the side flaps and the last flap toward you. Opening it toward you first means reaching over the exposed contents, and opening toward the patient or over the field risks contamination.

71. Why do CDC guidelines advise against artificial nails for clinicians who give direct patient care?

    1. A. They tear most gloves during injections
    2. B. They block alcohol rub from drying
    3. C. They harbor more bacteria after hygiene
    4. D. They cause latex allergy in patients
    Show answer

    Answer: C. They harbor more bacteria after hygiene

    Artificial nails and extenders carry more gram-negative bacteria and yeast than natural nails, before and after hand hygiene, and have been linked to outbreaks; CDC advises against them for direct care. They do not reliably tear gloves, stop alcohol from drying, or cause latex allergy.

72. Tuberculin and insulin syringes differ in that insulin syringes are:

    1. A. Larger than 10 mL in total volume
    2. B. Graduated in units rather than milliliters
    3. C. Supplied with no needle attached
    4. D. Meant for intravenous drugs rather than SC ones
    Show answer

    Answer: B. Graduated in units rather than milliliters

    Insulin syringes are marked in units (U-100) and tuberculin syringes in milliliters, so using one for the other's drug invites tenfold or larger dosing errors. Both are small syringes of 1 mL or less, insulin syringes usually come with a fixed needle attached, and insulin syringes are meant for subcutaneous injection, not IV drugs.

73. Before use, you prick your finger on a new, never-used sterile needle. This is:

    1. A. Not a bloodborne exposure; clean it
    2. B. A high-risk exposure requiring PEP
    3. C. A reason to test the patient for HIV
    4. D. An exposure to the next patient's blood
    Show answer

    Answer: A. Not a bloodborne exposure; clean it

    A bloodborne exposure requires contact with a patient's blood or body fluid; a clean, unused needle carries none, so clean the wound, discard the needle, and report per policy. Post-exposure prophylaxis and source testing are not indicated, and the next patient's blood was never involved.

74. A blunt-tip (fill) cannula is used for:

    1. A. Placing intradermal skin tests
    2. B. Giving drugs intramuscularly
    3. C. Starting peripheral IV lines
    4. D. Drawing drugs from a vial
    Show answer

    Answer: D. Drawing drugs from a vial

    Blunt fill cannulas reduce sharps exposure during drug preparation. It draws medication from a vial without a sharp needle.